Patient characteristics and outcomes associated with nitrovasodilator use in the treatment of acute heart failure.

Nitrovasodilators (NVs) are commonly recommended for the treatment of acute heart failure (AHF); however, registries suggest their use is not common. The objectives of this study were to determine patient characteristics associated with NV use and to explore the association between NV use and outcomes [length of stay (LoS) and inpatient mortality] in patients with AHF. A survey of US physicians (n = 426) who treat at least 5 AHF patients per month with NV provided a patient sample (n = 812 treated with NV and n = 322 not-NV) derived from chart review. Factors associated with NV use as well as patient characteristics and outcomes associated with NV use were explored using bivariate analysis, logistic regression, and negative binomial regression as appropriate. NV-treated patients were more likely to be female, have a higher systolic blood pressure, higher B-type natriuretic peptide and troponin, and stay in the intensive care unit while hospitalized, but less likely to be hyponatremic or hospitalized once previously. Overall, average LoS was 5.10 days (SD = 4.52) with 5.21 days (SD = 0.15) for the NV group and 4.94 days (SD = 0.31) for the non-NV group. The overall inpatient mortality rate was 2.1%. Among physicians who frequently use NV to treat AHF patients, there are distinct patient characteristics between NV treated and nontreated patients, suggesting a phenotype-driven approach. However, no differences in LoS or mortality were observed.